Background: The first long-acting injectable antiretroviral, cabotegravir/rilpivirine (LA-CAB/RPV), was FDA approved in January 2021 for persons with HIV suppressed on their current regimen. Body mass index (BMI) ≥30 kg/m2 has been identified as a risk factor for virologic failure, however data is limited due to small sample sizes. The aim of this study was to evaluate the impact of BMI on the efficacy of LA-CAB/RPV in a real-world setting.
Methods: A retrospective, multi-center cohort study was conducted from January 22, 2021 to February 15, 2023 in individuals who received LA-CAB/RPV every 4 (Q4w) or 8 weeks (Q8w). Individuals included were virologically suppressed on their current regimen, received at least one dose of LA-CAB/RPV, and had a follow up viral load post initiation.
Results: A total of 374 individuals across five centers were included, with a BMI ≥30 kg/m2 in 148 (39.5%) individuals. Most individuals received a Q8w (68%) regimen and the incidence of viral load >50 copies/mL was similar between those with BMI ≥ 30 kg/m2 (12%) as compared to those with BMI < 30 kg/m2 (9%) (IRR 1.31; 95% CI 0.69 - 2.46, p=0.4). Confirmed virologic failure occurred in 0.8% of individuals overall, with two of the three cases occurring in those with BMI ≥ 30 kg/m2.
Conclusion: The data from this real-world cohort demonstrates no difference in virologic outcomes for individuals with BMI ≥ 30 kg/m2 as compared to those with BMI < 30 kg/m2 suggesting that higher BMI alone should not preclude use of LA-CAB/RPV in eligible individuals.
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